Hanging Columella Reduction Under Local Anesthesia

Question

In a rhinoplasty 5 years ago my nasal bones were narrowed and tip rotated up. When I smile my nose looks pinched with an excessively wide alar base, and my columella hangs far below the tip giving my nose a cartoonish "hook" down. I have heard that is possible to have a septal reduction to lift the columella under local anesthesia, if that's the main problem. I'd like to avoid a full revision surgery if possible. Is this recommended? How can I find a surgeon who does this? What would it cost?

Raffy Karamanoukian, MD, FACS · Answer

The nasolabial angle will determine whether the columellar reduction should be performed under local anesthesia.  I perform these in my practice and use this tool as a guide.

Sam Naficy, MD, FACS · Answer

The hanging columella is often more complex than what may be apparent. Although some hanging columellas may be improved with a relatively easy procedure under local, many other hanging columellas require additional techniques and use of IV sedation

John M. Hilinski, MD · Answer

Looking at the one photo provided, it does appear that you have a hanging columella and a wide nasal base. Without seeing other views, it is somewhat difficult to determine what would be best in terms of a revision rhinoplasty procedure. Strictly speaking, the hanging columella can be addressed successfully under local anesthesia. This involves injecting an anesthetic solution in and around the bottom of the nose. The columella can then be approached with an incision made along both sides with subsequent adjustments made through this approach. Make sure you consult with a revision rhinoplasty specialist who has photos of other patients they have done using this technique. Good luck.

Eric M. Joseph, MD · Answer

I read your concern, and I reviewed the photo you posted. You may require revision rhinoplasty performed with general anestheitc to prevent your columella from hooking down when you smile. I doubt you would get significant improvement by having only your septum reduced under local anesthetic.

	You'll likely need to have your tip supported with a cartilage graft (C-strut), and have your lower lateral cartilages divided to allow your columella to rise up. Septal shortening may be performed at the same operation.

	All the best from NJ.

Behrooz Torkian, MD · Answer

Hi,

	This procedure can certainly be done under local anesthesia.  

	The best way to tell if you are a good candidate for this proceedure is to have a set of photos from the sides, 3/4 views, the front, and from under (worms eye).  The next step would be with a physical examination to determine the condition of the septum.  In some cases, the septum may have been removed or trimmed to allow for elevation of the collumella, but that does not always work.  If this is the case, then some cartilage grafting will have to be preformed.  

	In general, the injections required for local anesthesia are the most bothersome part of the proceedure.  Once you are numb, you should have a very smooth procedure.  

	I hope this helps.

	Dr. Torkian - Lasky Clinic, Beverly Hills.

Andres Bustillo, MD, FACS · Answer

Yes, revision rhinoplasty to correct your hanging columella can be done under local anesthesia. This may involve elevating the columella and placing it on the nasal septum (tongue in groove technique). This way the septum supports the columella.

William Portuese, MD · Answer

Certainly a tip plasty procedure can be done on the nose. The membranous and cartilaginous caudal septum are trimmed, bringing the columella up and inwards. Occasionally composite grafts have been put in the nostril rims to bring the alar rims down if they are retracted upwards. The tip plasty can be done under local anesthesia, but for most rhinoplasty procedures we do them under general anesthesia so that there is no conscious awareness while the procedure is being performed.

Michael A. Jazayeri, MD · Answer

Without an examination and side views, it is difficult to give a definitive answer.

	However, in most cases the cause of hanging columella is excess soft tissue between the columella and the septum, which can be removed under local anesthesia in the office.

Richard Sadove, MD · Answer

Dear 199543 in NY

	To answer your question: I have performed what we call a "caudal trim" for a hanging columella in my office under only local anesthesia. The body part is basically "external". Good luck.

Steven Wallach, MD · Answer

Without a full exam, it is hard to say.  Certainly rhinoplasty work can be done under sedation. I do not like doing things under local on this area, because of the discomfort.

Hanging Columella Reduction Under Local Anesthesia

Answers (13)

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